Basic Information
| Provider Information | |||||||||
| NPI: | 1063574234 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DAVID D SCHNEIDER MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 N 6TH ST | ||||||||
| Address2: | |||||||||
| City: | BELEN | ||||||||
| State: | NM | ||||||||
| PostalCode: | 870023605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058644646 | ||||||||
| FaxNumber: | 5058611843 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 N 6TH ST | ||||||||
| Address2: | |||||||||
| City: | BELEN | ||||||||
| State: | NM | ||||||||
| PostalCode: | 870023605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058644646 | ||||||||
| FaxNumber: | 5058611843 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2006 | ||||||||
| LastUpdateDate: | 04/29/2008 | ||||||||
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| AuthorizedOfficialLastName: | GRIER | ||||||||
| AuthorizedOfficialFirstName: | SHARON | ||||||||
| AuthorizedOfficialMiddleName: | ELIZABETH | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 5594384114 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 8091 | NM | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 73773 | 01 | NM | CARE | OTHER | 201008899 | 01 | NM | PRESBYTERIAN | OTHER | 659 | 01 | NM | LOVELACE | OTHER | 110144154 | 01 | NM | RR MEDICARE | OTHER | NM002745 | 01 | NM | BCBS | OTHER | 27201 | 05 | NM | MEDICAID |